Petition number: P-05-936

Petition title: Offer bowel cancer screening after the age of 74

Text of petition: The NHS in England, Scotland and Wales all offer Bowel Cancer screening every 2 years between the ages of 60 and 74.

In England and Scotland, you can request a screening kit every 2 years after 74.  This is NOT available to those over 74 in Wales.

This petition asks the Welsh Government to make bowel cancer screening available as it is in England and Scotland.

Ending the screening at 74 in Wales suggests that we do not value our seniors in the same way as they do in England and Scotland.

 


 

 

 

 

Background

The Bowel Cancer UK website states that bowel cancer is the fourth most common cancer in Wales. Every year more than 2,200 people are diagnosed with bowel cancer in Wales and over 900 people die from the disease. However bowel cancer is treatable and curable especially if diagnosed early. 

Screening is one of the best ways to diagnose bowel cancer early. The bowel screening programme began in Wales in 2008 and invited men and women aged 60 to 69 years to send a stool sample for guaiac faecal occult blood (gFOBt) testing every two years. In November 2012, the programme was expanded to include people aged 60 to 74.

In November 2015, the UK National Screening Committee[1] (UKNSC) recommended introducing the Faecal Immunochemical Test (FIT) into the bowel screening programme. Since January 2019, Bowel Screening Wales[JR(CyC|AC1]  has been providing FIT as part of the routine screening programme. As well as being more accurate, the new test is easier for people to use and the Welsh Government intends to gradually increase the sensitivity of this new test so that more cancers can be detected.

In August 2018, the UKNSC reviewed the optimisation of bowel screening and recommended that FIT should be available to people aged 50-74. The Welsh Government has committed to expand the programme to include men and women aged 50-59 by 2023. Correspondence from the Minister for Health and Social Services to the Committee on 15 January 2020 states that the risk of bowel cancer increases sharply from the age of 50 and the evidence shows that screening people in this age group would enable more bowel cancers to be picked up at an earlier stage, when treatment is likely to be more effective and survival chances improved.

Further information on screening in Wales is available on the Bowel Screening Wales website[JR(CyC|AC2] .

In England, people who are aged 75 or over can ask for a home testing kit every 2 years. In Scotland, people aged over 74 can request a screening kit by contacting the bowel cancer screening programme.

Bowel screening uptake

Public Health Wales publishes figures on bowel screening uptake[JR(CyC|AC3]  in Wales for eligible men and women aged 60-74 who are resident in Wales (available by Unitary Authority and Health Board). Figures for the financial year 2018-19 were published in January 2020 and show that the uptake total for Wales in 2018-19 was 57.3 per cent.

 

 

 

Welsh Government information

In correspondence from the Minister for Health and Social Services to the Committee on 15 January 2020, the Minister states that the policy in Wales is to only implement screening that is evidence based and has been recommended by the UKNSC and on the balance of the available evidence, the UKNSC does not recommend bowel screening beyond 74 years of age.

In answer to a Written Assembly Question[JR(CyC|AC4]  in May 2019, the Minister states that the upper age limit of bowel screening is based on the consideration of the risk of bowel cancer in people aged over 74 with no symptoms of the disease, and the risk to these individuals associated with carrying out screening, particularly from follow-up diagnostic procedures such as colonoscopy. Although serious complications from colonoscopy in the general population are uncommon, perforation of the bowel is one of the potential serious complications of further investigation. This occurs in around 1 in 1,500 procedures. The removal of polyps or tissue samples can cause heavy bleeding which in the general population occurs in about 1 in every 150 colonoscopies. The risk of these complications increases beyond the age of 74.

As population screening is not without risks, the Minister notes in his correspondence that there needs to be a balance between the benefits and harms of the screening test being offered. For asymptomatic bowel screening above the recommended age group, the additional risks from false positive results and any follow-up investigations outweigh the potential benefits in an older population. He goes on to say that going beyond the advice of the UKNSC by implementing something that has not been recommended, and for which there is no evidence of more benefit than harm, is not a safe or prudent way to deliver health services.

The Wales Screening Committee (WSC) is said to have considered the Welsh Government’s policy position not to offer bowel screening self-referral to those over 74 years of age in November 2019. The Committee agreed that clarification on the UKNSC position was needed before further considering self-referral for those over 74. The Chair of WSC has written to the Chair of the UKNSC requesting this clarity. Should the UKNSC recommend self-referral for people over 74 or a change to the upper age limit, the Minister highlights in his correspondence that the Welsh Government will consider how this can be delivered in Wales.

Anyone over the age of 74 in Wales can discuss their concerns with their GP who will decide whether further investigation is needed. Anyone with symptoms of bowel cancer should be referred for rapid investigation under the urgent suspect cancer referral process.

Screening in other countries

The Minister refers in his correspondence to the fact that self-referral into the bowel screening programme over the age of 74 is allowed in England and Scotland and recognises there is inequity of service provision. He goes on to say that bowel screening programmes in the majority of countries only provide bowel screening up to the age of 74 and do not allow self-referral beyond this age for the same reasons that the Welsh programme does not. Northern Ireland, New Zealand and Australia do not allow self-referral over 74.

 

National Assembly for Wales action

The Health, Social Care and Sport Committee undertook a one day inquiry into endoscopy services[JR(CyC|AC5]  in Wales and published its report[JR(CyC|AC6]  in April 2019. Section 6 discusses efforts being taken to increase the uptake of the bowel screening programme. The Welsh Government published its response[JR(CyC|AC7]  to the report and accepted the Committee’s recommendation. As a result of the Committee’s recommendation, the Welsh Government published a National Endoscopy Programme Action Plan 2019–2023[JR(CyC|AC8]  in October 2019.

 

 

Every effort is made to ensure that the information contained in this briefing is correct at the time of publication. Readers should be aware that these briefings are not necessarily updated or otherwise amended to reflect subsequent changes.

 

 

                                                                                                                                                                               



[1]The UK National Screening Committee advises ministers and the NHS in the 4 UK countries about all aspects of population screening and supports implementation of screening programmes.


 [JR(CyC|AC1]http://www.bowelscreening.wales.nhs.uk/hafan

 

 [JR(CyC|AC2]http://www.bowelscreening.wales.nhs.uk/hafan

 

 [JR(CyC|AC3]http://www.bowelscreening.wales.nhs.uk/adroddiadau-ystadegol

 

 [JR(CyC|AC4]https://cofnod.cynulliad.cymru/WrittenQuestion/78193

 

 [JR(CyC|AC5]http://www.senedd.cynulliad.cymru/mgIssueHistoryHome.aspx?IId=23027

 

 [JR(CyC|AC6]http://www.senedd.cynulliad.cymru/documents/s87032/Adroddiad%20-%20Gwasanaethau%20Endosgopi%20yng%20Nghymru.pdf

 

 [JR(CyC|AC7]http://www.senedd.cynulliad.cymru/documents/s90934/Ymateb%20Llywodraeth%20Cymru.pdf

 

 [JR(CyC|AC8]https://llyw.cymru/rhaglen-endosgopi-genedlaethol-cynllun-gweithredu-2019-i-2023